Applying a Poultice

This post is an tangent from my series on Healing Bone Fractures. In that series I have mentioned applying herbal poultices to my leg. I had considered including more details about applying a poultice in one of those posts but decided to do it separately so I can provide more details. I would like to thank my friend Elyse Portal who took some great photos while I was applying a poultice to my leg last weekend.

For the most part, a poultice is the most potent method of application of herbs to a localized area. This is because as the constituents of the herbs are absorbed into our tissues through the layer of moisture covering our skin, they are immediately replaced by more constituents from the herbs that diffuse into the layer of water. Also, the concentration of constituents is very high because the ratio of herb to liquid is very high. We are using a lot of herb and very little water.

We usually use dried herbs, but I often apply what I call a "survival poultice" if I get some kind of injury or bite when I'm wandering around in the fields and woods. In these circumstances I will find one or a few good healing herbs in my immediate area, chew them up and apply them where needed. I used to do this for my kids when they were small and we were on a hike or camping trip. You don't need to worry too much about bacteria in saliva because the antimicrobial properties of the herbs are very concentrated when applied this way and will take care of any risk of infection.

Here is the bowl of dried herbs I'm using for this particular poultice.

When using dried herbs, they should be coarsely ground. I usually rub them between my palms or use a mortar and pestle. We apply just enough boiled water to moisten them but so that they are not runny.

The herbs after moistening them with boiled water.

The purpose of the poultice I am preparing is to help heal the incisions from my surgery and to penetrate deeper into my leg to help heal my broken tibia (shinbone) as well. This poultice consists of 1 part common comfrey leaf (Symphytum officinale), 1 part stinging nettle leaf (Urtica dioica), 1 part purple loosestrife herb (Lythrum salicaria), 1 part pot marigold petals (Calendula officinalis), 1 part Canada goldenrod herb (Solidago canadensis) and 1/2 part whole flax seed (Linum usitatissimum). It is essential that a poultice is very mucilaginous. Comfrey is one of the few herbs that is mucilaginous enough that it doesn't require the addition of a more mucilaginous herb. However, since comfrey is only making up 20% of this formulation, it is necessary to add something to make it more slimy. My preference is to use a small amount of whole flax seed whenever I prepare a poultice. It will add the extra mucilage that we need and has important healing properties of its own. Never use ground flax seed. We just want the mucilage. We don't want to release the oil.

Getting ready to apply the poultice. At this point I had been poulticing the smaller incision on the right twice per day

for two weeks and the larger incision on the left for one week. There is clearly a difference between the two.

When applying a poultice I always put some gauze between the poultice and the skin. This serves two purposes: firstly, it ensures that small particles of herbs can't get into an open wound; secondly, it allows the poultice to be easily lifted off when finished without having to wipe bits of herb off the skin. This is important because when we remove the poultice we want any remaining herb infused liquid to dry on the skin. We use the minimum amount of layers of gauze to prevent bits of herb from getting through. The number of layers will depend on the thickness of the gauze.

Laying the gauze in preparation for the poultice.

When we apply the poultice we must completely cover an area a bit larger than the area we are working on with the moistened herbs and press down on them so that there is good contact with the skin. I usually apply it with a spoon and use the spoon to press the herbs once they are applied.

Beginning to apply the poultice...

...and finishing it off.

Under normal circumstances our skin is water-proof. In order to get the constituents of the herbs in our poultice to penetrate through our skin our skin must be hydrated to eliminate its water-proof characteristics. To accomplish this it is necessary for the entire area where we wish to apply the poultice to remain moist. We can't allow the skin to breathe. To accelerate this process it is also necessary that the poultice be applied as hot as we can tolerate and remain warm for the duration of the application. This process also takes time. The longer the poultice is in contact with our skin, the more hydrated our skin becomes and the better the penetration. I usually recommend a minimum of 30 minutes, but an hour or more is sometimes necessary, depending on the severity of the condition being treated. To facilitate the hydration of our skin it is best to wrap the poultice in plastic so that our skin remains in complete contact with herb infused liquid from our poultice and isn't able to breathe (no contact with air). Most types of plastic wrap are made of polyethylene which isn't known to leach any toxic chemicals. After wrapping the poultice I recommend pushing down on it once more to make sure there is good contact with the skin and no air spaces between the plastic and the herbs.

The poultice wrapped in plastic.

This whole process must be done as quickly as possible so that the herbs are still hot. Once the poultice has been wrapped in plastic it is necessary to cover it with a towel or something similar to help insulate it to keep it warm. If is going to be applied for a long period of time it may be necessary to apply a hot compress over the plastic. A cloth soaked in hot water that has been wrung out so that it isn't dripping will do. The cloth can be reheated periodically when it cools down. If the area where we need to apply the poultice isn't too large, a hot water bottle will also work and is more convenient than using a compress.

Covering the poultice with a couple of layers of towel.

Once we are done we can remove the poultice. For my leg, I have been applying a poultice for 45-60 minutes twice per day. When we use gauze the whole thing will lift off really easy.

The poultice has been uncovered and is ready to be removed.

When we remove the poultice the skin will be moist with herb infused liquid. We don't want to wipe this off. Let it dry completely before covering the area.

After removing the poultice we let the remaining liquid completely dry on the skin.

Notice the larger droplets of herb infused water.

Once the remaining herb infused water has dried completely the process is complete. We can bandage the area, if necessary, or cover it in some other way. We can also apply an ointment or liniment to the area, if appropriate, to further assist the healing process.

Which herbs we use, how often and how long we apply a poultice will depend on the situation, but the basic elements of applying a poultice will always be the same.

Healing Bone Fractures, Part 3 of 5

This is the third in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In Part 2 I provided a detailed account of the protocols that I implemented when I returned home. In this post I am providing an update on how things are progressing four weeks after my surgery and any modifications that I have made to the protocols that I am using.

Systemic Herbal Formulation: On the fifth day after my surgery I was finally able to make a specific herbal formulation to treat my injury. I made up a 250 bottle, which lasts two weeks at the dose I am taking (for the details see Part 2). This formula ran out during the third week after my surgery. Although I was only taking it for two weeks and I could have just repeated the same formula, I decided to make a slight change to the formula. Since there is no evidence of nerve damage, I eliminated the St. Johnswort (Hypericum perforatum). I also substituted stinging nettle (Urtica dioica) for common horsetail (Equisetum arvense). The second version of the formulation contains turmeric rhizome (Curcuma longa) 18%, stinging nettle herb (Urtica dioica) 20%, boneset herb (Eupatorium perfoliatum) 20%, American plantain herb (Plantago rugelii) 20%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. I am continuing to take 6 ml three times per day on an empty stomach, 5-10 minutes before each meal.

St. Johnswort (Hypericum perforatum), topically, systemically and in homeopathic potencies,

is a very important herb for healing nerve damage.

Herbal Sleep Formulation: Due to the changes to my primary systemic formulation I made a slight adjustment to the sleep formulation as well so that the two formulations remain well coordinated. It now contains English lavender flowering spike (Lavandula angustifolia) 15%, St. Johnswort herb (Hypericum perforatum) 15%, catnip herb (Nepeta cataria) 15%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, stinging nettle herb (Urtica dioica) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. Once more this formula overlaps with and carries over some of the properties of my daytime formula while still maintaining its effectiveness as a sleep formula. Just as with plantain, it is rare for stinging nettle herb to be acknowledged as a sedative in the herbal literature. In fact, it is a very calming herb, especially when harvested a bit later in its life cycle when a some of the harvested portion includes the immature seeds. These are the most sedating part of the plant. I am continuing to take 6 ml immediately before bed and additional 3 ml doses through the night, as required.

More On Sleep: For reasons that I explained in Part 2, getting sufficient sleep has been a real challenge for me, even with the herbal sleep formula. By day 23 after my surgery I still had experienced only a slight improvement in my sleep, so I decided to go one step further and take melatonin as well. In the past I have found that clients with moderate to severe insomnia for whom an herbal sleep formula does not produce sufficient results usually respond well to the addition of a small amount of melatonin into the mix. Although I am not experiencing typical insomnia, my hope was that this will help me to sleep deeper and I won't wake up as much due to the discomfort and stiffness I have been experiencing as a result of having to lie on my back all night. I have to say, I was appalled at the poor selection of melatonin products even in a very well stocked health food store. Most of them had additional undesirable ingredients such as high doses of individual B vitamins or calcium. In addition, the doses of melatonin were way too high. Melatonin is a hormone and, although it is safe when used correctly, it is important to use only the minimum dose that will produce the desired results. The way I recommend people take it is to begin with a 0.5 mg dose for a few days. If that isn't strong enough I have them increase the dose in 0.5 mg increments (allowing a few days each time the dose is increased to determine its effectiveness) until they hit the ideal dose for them. One of the advantages of using melatonin in combination with a good herbal sedative is that they are mutually synergistic and, when taken concurrently with the herbs, the melatonin will usually produced the desired result at a very low dose. Although I did find a few products that had relatively low (1 mg) dose of melatonin, they all had other things in them that I didn't want to take. As a result, I ended up purchasing a 3 mg sublingual lozenge that I am able to cut into quarters so that each dose is approximately 0.75 mg. I take 0.75 mg of melatonin about 15 minutes before I go to bed and then take a 6 ml dose of my sleep formulation just before bed. When I wake up in the night and have difficulty falling back to sleep, if it seems that I won't have too much difficulty falling asleep I will take an additional 3 ml dose of the tincture. However, if it seems that I am going to have more difficulty, I will allow myself one more 0.75 mg dose of melatonin in addition to 3 ml of the tincture. If I wake up additional times through the night and have difficulty falling asleep I will only take the tincture. As it turns out, the first night I required two doses of melatonin but after that my sleep improved so much I only required one. I have found that I am waking up less often through the night and having less difficulty falling back to sleep when I wake up.

Homeopathics: On day 23 after my surgery, when I added the melatonin, I also diverged from the homeopathic protocols that I had intended to follow (as indicated in Part 2). I am continuing to take Symphytum 200C three times per day to support the healing of my bone. Since I was past the stage of the initial tissue trauma, I dropped the Arnica. As there seemed to be no major nerve damage, but there is a little bit of numbness of my skin along the major incision, I dropped the Hypericum 200C to one dose per day. To address the mild numbness I also kept Hypericum (St. Johnswort) in my sleep formulation even though I eliminated it from my daytime formulation. I also added Rhus 200C two doses per day. Rhus is for injuries or strains that stiffen up and feel worse when they are rested for periods of time, but feel better when we move around. These symptoms are typical for me whenever I have injuries or stiffness. I always feel better when I can move around and limber up. My hope was that the Rhus will help reduce the stiffness I am experiencing from lying on my back all night, since this stiffness is one of the things interfering with my sleep. It has helped somewhat and I have experienced a significant improvement in my sleep since adding the Rhus and melatonin to my protocols. It is my intention to continue taking these three homeopathic remedies in these doses for the next few weeks.

Eastern poison oak (Toxicodendron pubescens) was formerly classified as Rhus toxicodendron.

The names of homeopathic remedies are often based on obsolete botanical names

so as to maintain the continuity of the name with older homeopathic texts.

Topical Herbal Preparations: I have two incisions in my leg. A smaller one just below my knee and a larger one that runs down to my ankle which is the area where the plate was put in. On day 13 after my surgery all of the stitches in the smaller incision were removed, but the surgeon decided to remove only half of the stitches in my larger incision because the inflammation and edema were putting a lot of pressure on that area. He wanted me to come back in two more weeks to have the remainder of the stitches removed. On day 16 we began applying a poultice to the smaller incision from which all of the stitches had been removed (for more details about the poultice, see Part 2). We decided to use it as an opportunity to demonstrate how to apply a poultice during our Making Herbal Tinctures workshop. By day 18 it was apparent that the healing of the smaller incision was already much further along than the larger incision to which I was not yet able to apply a poultice because of the remaining stitches. I tried to get an appointment that week to see the surgeon and have the remaining stitches removed so that I could begin working on the longer incision, but there were no appointments available. As a result, I decided it was best if I removed the stitches before my appointment the following week. On day 23, herbalist (and my partner) Monika Ghent removed them for me in the morning. We allowed the holes to seal during the next few hours and began applying a poultice to the larger incision as well that night.

This photograph was taken of my leg just before we removed the remaining stitches from the larger incision.

Notice how much further along the healing is on the smaller incision which at this point I had been

poulticing for a week. The redness is in areas that were formerly covered by scabs.

Since then the protocol that I have been using is as follows:

• When I wake up I apply the liniment I am using (see Part 2) to my whole lower leg up to and including my knee, but not to the area of the incisions themselves. I apply an ointment to the incisions. The ointment is made from the same infused oil that I used as the base for my liniment (see Part 2) with a little bit of English lavender (Lavandula angustifolia) essential oil added to it (probably about 2 drops in each 25 ml jar). Both the infused oil and the ointment were made during our Herbal Field Studies field workshops.
• In the mid afternoon I apply a poultice to both incisions (for details see Part 2). I leave them on for 30-45 minutes and then remove them and allow the plant juices to dry on my leg. I do not apply anything else at that time.
• In the evening I apply a second poultice to both incisions. However, after I remove them and the plant juices dry on my leg I apply a comfrey (Symphytum officinale) ointment to my whole lower leg below the knee including the incisions. I had not prepared any comfrey ointment but fortunately my friend and fellow herbalist Rick DeSylva provided me with an jar of his excellent comfrey ointment.

This is what the protocols I am using look like at about 4 weeks after my surgery. There is no pain in my leg even when I touch the area where the incisions and fractures are. The surgeon was quite surprised at that. My leg feels strong and I am doing my best to stretch the tendons and ligaments in my ankle and knee so they don't tighten up too much while I'm not walking. There is some edema in my foot because I am spending a fair bit of time upright, which allows the blood and lymph to pool in my foot. This is has gone down somewhat but is still significant except when I wake up in the morning after I've been horizontal through the night. It is something I'm going to have to put up with until I start walking unless I want to spend the whole day sitting or lying with my leg raised, which is not an option.

I will continue provide updates on how things are progressing and any changes to my protocols in Part 4.

Healing Bone Fractures, Part 2 of 5

This is the second in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In this post I am going to explain the protocol that I implemented when I returned home.

I returned home on evening of Sunday February 3rd, four days after my injury and three days after my surgery. On Monday we picked up some additional supplements that I needed and then on Tuesday I made up a couple of new formulations specifically formulated to address my injury. This is the protocol that I implemented at that time:

Homeopathics: I am taking Arnica 200C, Hypericum 200C and Symphytum 200C individually, four pellets per dose alternated throughout the day. The dosage of each remedy varies over time according to the following protocol:

• Week 1: Arnica 4 doses per day; Hypericum 4 doses per day; Symphytum 4 doses per day.
• Week 2: Arnica 3 doses per day; Hypericum 3 doses per day; Symphytum 3 doses per day.
• Week 3: Arnica 2 doses per day; Hypericum 2 doses per day; Symphytum 3 doses per day.
• Week 4: Arnica 1 dose per day; Hypericum 1 dose per day; Symphytum 3 doses per day.
• Week 5 and onwards (until my bones are completely healed): Symphytum 3 doses per day.

Herbs: I created three new formulations to address my specific needs:

• A systemic herbal formulation prepared from 1:5 fresh herb tinctures containing turmeric rhizome (Curcuma longa) 18%, common horsetail herb (Equisetum arvense) 15%, boneset herb (Eupatorium perfoliatum) 15%, St. Johnswort herb (Hypericum perforatum) 15%, American plantain herb (Plantago rugelii) 15%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. This formulation is a specific for healing damaged tissues and blood vessels, bone, and improving general circulation. Boneset and turmeric also have a significant tonic action on the liver which will help address any stress on my liver from the medications and other aspects of my hospital experience, as well as protect my liver from any toxicity from the pyrrolizidine alkaloids in the comfrey, which is the best herb I know for healing bones and well worth the very slight risk of toxicity. Given that the comfrey will not exceed the 15-20% range in any of the formulations that I use and will be combined with herbs that can mitigate its potential toxicity, the likelihood of any toxicity is almost nil. Boneset and horsetail are also specifics for healing bone tissue. This formulation is taken in 6 ml doses three times per day on an empty stomach, 5-10 minutes before each meal.

Boneset (Eupatorium perfoliatum) is an excellent healing herb that is very effective for the healing of bone tissue.

• A systemic herbal sleep formulation prepared from 1:5 fresh herb tinctures containing English lavender flowering spike (Lavandula angustifolia) 20%, St. Johnswort herb (Hypericum perforatum) 20%, catnip herb (Nepeta cataria) 20%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. The dosage of this formulation is 6 ml immediately before bed and additional 3 ml doses through the night, as required. Getting sufficient sleep is one of my greatest challenges. I tend to be a light sleeper. I sleep on my sides and wake up four or five times a night feeling a bit stiff and change my position, flipping from side to side and then falling back to sleep fairly quickly. With my broken leg I can only sleep on my back. This is difficult for me because as a general rule I can't sleep on my back, and it also doesn't allow me to shift my position sufficiently. By half way through the night my lower back is very stiff and sore. Most nights I'm only getting five to six hours sleep, and that's with the sleep formulation. Occasionally I get a bit more. Getting sufficient sleep is critical to the healing process, so I made this formulation to help me sleep better. Notice that it contains a few of the herbs that are in my daytime formulation. This is to help continue to support the healing process through the night. It is also important that the overlapping herbs contribute to the sleep formulation. You will find few, if any, references to plantain having sedative properties, but it does. As a general rule, whenever someone is taking more than one herbal formulation concurrently, it is usually preferable if there is some overlap between the herbs in the different formulations. As in this case, the overlapping herbs must contribute to the desired actions of both formulations.
• A topical liniment made up of a base containing 1:5 fresh herb infused oils of pot marigold flower head (Calendula officinalis), Canada goldenrod leaf (Solidago canadensis), wild bergamot herb (Monarda fistulosa), coltsfoot leaf (Tussilago farfara), St. Johnswort herb (Hypericum perforatum), northern white pine leaf (Pinus strobus) and American plantain herb (Plantago rugelii). This infuse oil was prepared last year. The herbs are in descending order based on proportion as I am not certain of the exact percentages. To the base oil I added the following essential oils at an overall potency of two drops per ml of base oil: rosemary leaf (Rosmarinus officinalis) 25%, English lavender flower (Lavandula angustifolia) 25%, black spruce leaf/twig (Picea mariana) 15%, marjoram herb (Origanum majorana) 10%, eastern hemlock leaf/twig (Tsuga canadensis) 10%, Roman chamomile flower head (Chamaemelum nobile) 5%, yarrow herb (Achillea millefolium) 5% and eastern white cedar (Thuja occidentalis) 5%. I apply this twice a day, immediately upon waking and just before bed, to the lower thigh, knee and half of the foot of my injured leg as my leg below my knee and half of my foot are covered by a tensor bandage. I also apply it to the hip, knee and ankle of my left leg, and my wrists, as these areas are being stressed in unusual ways due to using crutches.

In this photograph we have common plantain (Plantago major), an alien species that has naturalized throughout

North America, on the left, and American plantain (P. rugelii), our native species, on the right. Notice the

reddish colour at the base of the petioles (leaf stalks) of American plantain. Most people

(including herbalists) don't realize that these are two different species.

Two weeks after my surgery I went to the hospital to have my stitches removed. There was a lot of pressure on my stitches due to the edema in my leg that occurs whenever I am moving around in an upright position. The blood and lymph tends to pool in my leg because I am not using my leg to walk, which is necessary to efficiently pump the fluids out of my leg against the force of gravity. As a result, the doctor decided to leave every second stitch in my lower, longer incision for another two weeks. In the mean time, beginning a couple of days after I got my stitches out I started poulticing the shorter incision from which all of the stitches were removed. I am applying a poultice twice per day for 30-45 minutes. The primary herbs that I am using are common comfrey leaf (Symphytum officinale), stinging nettle leaf (Urtica dioica), pot marigold petals (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), and a bit of whole flax seed (Linum usitatissimum) to increase the mucilage content. I use these herbs in roughly equal proportions (except for the flax seed) and each time add a sixth herb in a similar proportion. I have a lot of "ends" which are small quantities of herbs that are left over from when I harvest herbs to make tinctures. I dry these remainders and use them when the opportunity arises. This is one of those opportunities. Each time I make a poultice I use a different sixth herb. Some of the herbs that I have used so far include elecampane leaf (Inula helenium), wood nettle leaf (Laportea canadensis), Canada goldenrod herb (Solidago canadensis), blueweed herb (Echium vulgare), blue vervain herb (Verbena hastata), wormwood herb (Artemisia absinthium), yarrow herb (Achillea millefolium), yellow bedstraw herb (Galium verum) and pearly everlasting herb (Anaphalis margaritacea).

Supplements: I was able to obtain the additional supplements that I need over the course of the first week that I was back so that since about a week and a half after my injury I have been on the full complement of supplements that I need to help heal my leg. These supplements are very important whenever there is significant tissue damage, but they are particularly important for healing damaged bone, cartilage, tendons and ligaments, regardless of the cause of damage. I use a similar supplement regimen for the treatment of osteoarthritis and osteoporosis. Although there are a number of supplements available that are formulated for building bone tissue that contain some of these nutrients, I chose not to use any of them because I didn't like any of the formulations. All of them were missing important nutrients, had way too much calcium relative to the other ingredients, and most of them were compromised in some way by using cheaper, low quality ingredients such as magnesium oxide. As a result, I had to put this supplement regimen together using a fair number of products. Nevertheless, the importance of using all of these nutrients in the right balance can not be over emphasized. I have listed them here by nutrient instead of by which ones I am taking with each meal, as I did in the first post of this series, so that it is more clear what I am taking. All of these are taken with meals:

• Vitamin A: 3,500 IU with breakfast; 3,500 IU with dinner.
• Beta-carotene: 750 IU with breakfast; 750 IU with dinner.
• Vitamin C (calcium and magnesium ascorbate): 1,485 mg with breakfast; 1,360 mg with lunch; 1,485 mg with dinner.
• Vitamin D: 1,200 IU with breakfast; 1,000 IU with lunch; 1,400 IU with dinner.
• Vitamin E (mixed tocopherols, acetate): 115 IU with breakfast; 40 IU with lunch; 315 IU with dinner.
• Vitamin K: 60 mcg with breakfast; 80 mcg with dinner.
• Calcium (citrate, ascorbate, malate): 150 mg with breakfast; 135 mg with lunch; 450 mg with dinner.
• Magnesium (citrate, ascorbate, malate): 60 mg with breakfast; 60 mg with lunch; 260 mg with dinner.
• Zinc (citrate): 5 mg with breakfast; 25 mg with dinner.
• Silicon (aqueous horsetail extract): 4.7 mg with breakfast; 4.7 mg with lunch; 4.7 mg with dinner.
• Manganese (chelate, citrate): 0.5 mg with breakfast; 5.5 mg with dinner.
• Copper (citrate): 0.5 mg with breakfast; 1.5 mg with dinner.
• Boron (chelate): 350 mcg with breakfast; 350 mcg with dinner.
• Selenium (chelate): 50 mcg with breakfast; 150 mcg with dinner.
• Polyphenol complexes (flavonoids, anthocyanidins, proanthocyanidins and catechins from extracts of berries, citrus, grape seed and green tea): 325 mg with breakfast; 225 mg with lunch; 325 mg with dinner.
• Quercetin: 100 mg with breakfast; 100 mg with lunch; 100 mg with dinner.
• Lutein: 0.5 mg with breakfast; 0.5 mg with dinner.

Blueberries (Vaccinium spp.) are a very rich source of anthocyanins and flavonoids, including quercetin.

Some of these are ingredients from a multivitamin that I am taking with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. Mostly what I haven't listed are the B vitamins and some of the other trace minerals. In addition, I am also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

In addition to the above supplements that I am taking with meals, I am also taking the following on an empty stomach three times per day 30 minutes before each meal:

• Methylsulfonylmethane (MSM) 400 mg.
• Glucosamine hydrochloride 300 mg.
• Betaine 80 mg.
• Hyaluronic acid 10 mg.

Probiotics: Another one of the challenges that I am dealing with is constipation. It started with fasting from food and water for 16 hours before my surgery and was further aggravated by the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night after my surgery. However, the ongoing issue is that I am spending a lot more time sitting and can't walk or run, which is important for good bowel tone. I am addressing this by taking a high potency probiotic supplement that contains 25 billion active cells of a combination of eight active strains of bacteria. I take this first thing in the morning in a glass of warm water with a tablespoon of whole organic flax seed. My bowel movements gradually returned to normal during the first week that I took this and I am continuing to take it on an ongoing basis.

Lactobacillus rhamnosus: An important probiotic species.

Exercise: This is another of my major challenges. The surgeon wants me to spend most of my day sitting or laying with my injured leg raised. This is not an option. It's bad enough that the muscles in my right leg are getting weaker. I'm not going to sit around and let my whole body atrophy. Plus, I have clients and students that depend on me and lots of work to be done. My life has definitely slowed down and there are many things that are too difficult or impossible for me to do, but I'm not out of commission completely. I have sit stations all over my house where I work, eat and rest consisting of a padded chair to sit on and a second chair with a pillow on it that I can put my leg up on. I have found that there is a delicate balance between sitting and moving around upright. If I do either for too long, the edema in my lower right leg gets worse.

Aside from the exercise I get moving around on crutches, every morning before breakfast I do an upper body workout with light weights and lots of stretching. I'm also working my injured leg as best I can. Whenever I'm sitting for periods of time I periodically massage my thigh and knee. I also wiggle my toes a lot and gently stretch the tendons and ligaments in my ankle and knee. In addition, I'm doing my best to work out my right knee and hip as best I can without being able to walk. To maintain some level of strength in these joints I do leg lifts from my hip raising my whole leg, and from my knee raising my lower leg several times per day for a few minutes. I also "pump" my leg while I'm walking on crutches by raising my leg and bending my knee on one step and then lowering my leg on alternate steps. As before I also continue to do deep breathing exercises in which I "feel" the life force or qi energy flowing into and out of my leg.

Diet: My diet is pretty good in general. It is almost completely organic and I get a lot of variety. My only concern is getting a bit more good quality protein. I have been a vegetarian for 33 years. Contrary to what some people believe, it is very easy for vegetarians to consume sufficient protein. Nevertheless, a good supply of high quality protein is necessary to heal bone tissue. Rather than bump up some of the typical high protein vegetarian foods such as beans or nuts which are harder on the digestive system, I have decided to increase my protein somewhat by eating one or two organic, free-range eggs most days. I have to strike a balance here and not eat too many eggs because for me eggs tend to be constipating.

So there you have it! This is the regimen I am following at this time. It is very intensive. I probably spend about 10% of my waking hours engaged in some aspect of this healing protocol. However, that's not bad considering I am still working at about 60% capacity instead of laying around like the surgeon advised me to. Also, with the exception of the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night immediately after my surgery, I did not fill the prescription for painkillers that the surgeon gave me and only had to take a single dose of acetaminophen about 24 hours after my surgery. When I had the stitches removed, the surgeon prescribed another course of antibiotics and some anti-inflammatories. I didn't fill those prescriptions either. My intent is not only to stay relatively functional through this process, but also to make sure that my bones heal well and are strong enough to allow me to continue doing what I've always done. I'm also hoping to be able to start putting some weight on my leg a fair bit earlier than the three to four months that the surgeon predicted.

Overall, I have to say that the biggest challenge for me has been not being able to walk the land. In my normal life, every day I take my dogs out for about an hour and a half and walk the trails through the fields and forest where I live. Aside from the obvious benefits of the exercise and fresh air for the dogs and myself, it provides me with an opportunity to deepen my ongoing relationship with the land; to observe what changes are taking place; to stop periodically at one or more of my favorite sit spots and just be. I'm also missing the winter. Last year was the warmest winter I can remember. There was pretty much no snow. This year we are having a somewhat more "normal" winter. I am missing walking through the snow; breathing the cold, crisp air; feeling the wind on my face; the calls of the chickadees, goldfinches and nuthatches. At best a couple of times a week when the conditions are good I can put the spiky snow things on the bottom of my crutches, go out and sit behind my house by our fire pit and gaze out over the landscape. I really do appreciate those moments.

"The Land" in winter.

Most of the details relating to the protocols that I am using have been covered in these first two parts of this series. From Part 3 of this series onwards I will discuss any changes that I make to these protocols and provide updates on how things are progressing.